The Effects of Employment on Mental Health and Executive Functions in Adults with Autism Spectrum Disorder (ASD)

Background: Little is known about life for adults with Autism Spectrum Disorder (Howlin, 2013). This is worrying because research suggests adults with ASD experience poorer mental health than those without ASD (Joshi et al., 2013) with depression commonly reported (Moss et al., 2015). Some research also indicates executive functions (higher-order cognitive processes including planning, flexibility and inhibition) are also associated with difficulty in ASD (Hill, 2004). Few adults with ASD are in employment despite many being able and willing to work. However, employment can be seen as one route to independence and social inclusion. The effects of employment on mental health in adults with ASD are unknown. However, one study has suggested improved executive functioning performance following participation in a supported employment scheme in adults with ASD (Garcia-Villamisar & Hughes, 2007).

Objectives: This study will focus on mental health and executive functioning with the hypothesis that mental health and executive functioning will improve after a period of employment in adults with ASD.

Methods: 20 adults (age 18+) with ASD and 20 individuals without ASD (matched on IQ, age and gender) will take part. Those with intellectual disability, DCD, ADHD or dyslexia are excluded. Participants will be assessed at two time points: pre-employment and post-employment. Each session will involve a series of mental health questionnaires and executive functioning tasks. All participants will be unemployed at the pre-employment stage and employed, or have just completed a period of employment, at the post-employment stage.

Results: To date, eleven adults with ASD have taken part. Most participants are males (91%) aged 20-36 (M = 25.6, SD = 4.3). Pre-employment, participants reported mild symptoms of depression (M = 6.2, SD = 5.4), few or no symptoms of anxiety (M = 4.0, SD = 3.5), slightly below average levels of life satisfaction (M = 17.3, SD = 8.3) and slightly lower than average levels of well-being (M = 43.6, SD = 8.3). Initial data from the present study suggest an improvement in well-being (t(6) = -2.19, p = .036), verbal fluency (t(6) = -2.14, p = .039), cognitive flexibility(t(6) = 2.49, p = .024) and response inhibition (t(6) = 3.57, p = .006) after a period of employment.

Conclusions: Whilst this is extremely tentative, as data collection and analysis are ongoing, the preliminary findings support the hypothesis that an improvement in mental health and executive functioning is observed in adults with ASD after a period of employment. This supports clinical guidelines recommending individual supported employment as a psychosocial intervention for adults with ASD (NICE, 2012) and links to funding opportunities for specialist adult ASD employment services. Few of these services exist and an improvement in well-being and some aspects of cognition means many adults with ASD would benefit from specialist supported employment services. Finally, the present study supports recent statutory guidance in the United Kingdom recommending employment be included in needs assessments for adults with ASD.